全髋关节置换术后总失血量和血生化指标变化的量效关系

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摘要 目的: 探究创伤后全髋关节置换（THA）术后血清钾、钙、白蛋白（ALB）及血红蛋白（HGB）的变化规律,为围术期的安全管理提供依据。方法: 回顾性分析2017年9月―2022年9月因股骨颈骨折于岳阳市人民医院关节科112例接受THA的患者资料。结果: THA术后平均总失血量为（798.74±265.34） mL,隐性失血量为（428.12±195.45） mL,占总失血量的54.21%;全髋置换术后血清钙、ALB、HGB水平较术前显著下降,而血清钾水平较术前无明显变化;THA总失血量与患者血清钙、ALB及HGB的变化量呈显著正相关,回归方程为：Y=0.000216X、Y=0.00919X、Y=0.0280X,R²分别为：0.738、0.860、0.945;术前血清钙<2.27mmol/L、ALB<37.26g/L、HGB<122.11g/L的患者术后生化指标异常的发生率显著增加。结论: 血清钙、ALB、HGB浓度下降与THA总失血量具有一定的量效关系。临床中,一般人群可根据平均失血量预测术后血生化指标的变化量,以此可设立相关指标的术前预警值,对估计THA术后相应指标的变化情况并提前干预提供了有效的帮助。

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	曹阳
	刘芳

关键词 ：全髋关节置换术, 失血量, 低蛋白血症, 低钙血症, 贫血

Abstract：Objective To investigate the pattern of changes in serum potassium, calcium, albumin (ALB) and hemoglobin (HGB) after traumatic total hip replacement (THA), so as to provide a basis for perioperative safety management. Methods The data of 112 patients who underwent THA for femoral neck fracture at the Department of Arthroplasty of Yueyang People's Hospital from September 2017 to September 2022 were retrospectively analyzed. Results The mean total blood loss after THA was (798.74±265.34) mL, and the hidden blood loss was (428.12±195.45) mL, accounting for 54.21% of the total blood loss; serum calcium, ALB, and HGB levels decreased significantly after total hip replacement compared with preoperative levels, while serum potassium levels did not change significantly compared with preoperative levels; total THA blood loss was significantly and positively correlated with the amount of change in patients’ serum calcium, ALB and HGB, and the regression equations were Y=0.000216X, Y=0.00919X, Y=0.0280X, with R²: 0.738, 0.860, 0.945, respectively; The incidence of postoperative biochemical index abnormalities was significantly increased in patients with preoperative serum calcium <2.27mmol/L, ALB<37.26g/L, HGB<122.11g/L. Conclusion There is a quantitative relationship between the decrease in serum calcium, ALB, and HGB concentrations and the total blood loss in THA. In clinical practice, the change values of postoperative blood biochemical indexes can be predicted based on the mean blood loss in the general population, so as to set up the preoperative warning value of relevant indicators, which provides effective help to estimate the changes of corresponding indicators after THA and advance intervention.

Key words： total hip arthroplasty total blood loss hypocalcemia hypoproteinemia anemia

收稿日期: 2022-10-30

中图分类号:

R687.4

基金资助:湖南省卫生健康委员会科研项目（B2017239）

通讯作者: 刘芳,E-mail：liufangrenbo@163.com

引用本文:

曹阳, 刘芳. 全髋关节置换术后总失血量和血生化指标变化的量效关系[J]. 湖南师范大学学报(医学版), 2023, 20(1): 76-79. CAO Yang, LIU Fang. Volume-effect relationship between total blood loss and serum biochemical index changes after total hip arthroplasty. HuNan ShiFan DaXue XueBao(YiXueBan), 2023, 20(1): 76-79.

链接本文:

http://yxb.hunnu.edu.cn/CN/ 或 http://yxb.hunnu.edu.cn/CN/Y2023/V20/I1/76

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